Opioid-induced chest wall rigidity is an uncommon complication of opioids. Because of this, it is often difficult to make a differential diagnosis in a mechanically ventilated patient who experiences increased airway pressure and difficulty with ventilation. A 76-year-old female patient was admitted to the intensive care unit (ICU) after surgery for periprosthetic fracture of the femur neck. On completion of the surgery, airway pressure was increased, and oxygen saturation fell below 95% after a bolus dose of fentanyl. After ICU admission, the same event recurred. Manual ventilation was immediately started, and a muscle relaxant relieved the symptoms. There was no sign or symptom suggesting airway obstruction or asthma on physical examination. Early recognition and treatment should be made in a mechanically ventilated patient experiencing increased airway pressure in order to prevent further deterioration.
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Fentanyl-Induced Rigid Chest Syndrome in Critically Ill Patients Alison J. Tammen, Donald Brescia, Dan Jonas, Jeremy L. Hodges, Philip Keith Journal of Intensive Care Medicine.2023; 38(2): 196. CrossRef
Effects of fentanyl overdose-induced muscle rigidity and dexmedetomidine on respiratory mechanics and pulmonary gas exchange in sedated rats Philippe Haouzi, Nicole Tubbs Journal of Applied Physiology.2022; 132(6): 1407. CrossRef
Challenges in Sedation Management in Critically Ill Patients with COVID-19: a Brief Review Kunal Karamchandani, Rajeev Dalal, Jina Patel, Puneet Modgil, Ashley Quintili Current Anesthesiology Reports.2021; 11(2): 107. CrossRef
A Case of Masseter Muscle Rigidity during Awake Intubation under Remifentanil Infusion Tomoki YAMAGA, Takeshi NEGITA, Masayo SUGIURA, Nobuyuki KIMURA THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA.2019; 39(3): 274. CrossRef
Opioids and Chest Wall Rigidity During Mechanical Ventilation Jeffrey P. Roan, Navin Bajaj, Field A. Davis, Natalie Kandinata Annals of Internal Medicine.2018; 168(9): 678. CrossRef